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248 Cards in this Set
- Front
- Back
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What is associated with ostium primum heart defects?
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Down's syndrome
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What heart murmur results from acute rheumatic fever vs chronic rheumatic heart disease?
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Acute: mitral regurg; chronic: mitral stenosis, possibly aortic stenosis
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Which endocarditis causes vegetations on both sides of the mitral vs only one side?
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Libman-Sacks causes vegetations onboth sides; marantic endocarditis on one side
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What type of cardiomyopathy is associated with pregnancy?
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DCM
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What is a common cause of pneumonia superimposed on COPD?
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H. flu, Moraxella catarrhalis, Legionella
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What condition increases the risk of necrotizing enterocolitis in a neonate?
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Neonatal respiratory distress syndrome
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What is the most common lung tumor in male smoker? Female smoker? Nonsmoker?
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Male = squamous, female = adenocarcinoma, nonsmoker= adenocarcinoma
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What cell does bronchioalveolar carcinoma arise from?
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Clara cell
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What is the most common tumor of the lung?
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Metastasis
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Who gets allergic bronchopulmonary aspergillosis and what are the symptoms?
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CF or asthmatic with bronchiectasis; have cough, dyspnea, and foul smelling sputum
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What is the CD4/CD8 ratio in hypersensitivity pneumonitis? What type of hypersensitivity is it?
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Low; type III/IV
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What patients get hypersensitivity pneumonitis? What is the long term effect of exposure?
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Farmers, people who work with birds; granulomas with eosinophils leading to pulmonary fibrosis
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What is dysplastic kidney and how is it inherited?
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Cartilage, cysts in kidney; not inhertiable
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What is the BUN/creatinine ratio in prerenal, intrinsic, and postrenla failure?
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Prerenal it is >20, intrinsic is 10-15, postrenal is >20 initially and then <15 in long standing damage
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What type of nephrotic syndrome develops in sickle cell patients?
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FSGS
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What cell produces erythropoietin?
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Renal peritubular interstitial cells
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What cell creates 1,25 vitamin D?
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Proximal tubule
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What type of transitional cell carcinoma has early p53 mutations?
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Flat pathway (not papillary)
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Where does cervical cancer spread to first?
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Spreads locally; invades bladder and results in hydronephrosis
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What type of acid/base imbalance is present in pulmonary embolism? Why does this happen?
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Respiratory alkalosis; irritation of lung stimulates the J receptor, which increases breathing rate
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What is the associated risk for endometriosis of the ovary?
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Increases risk of endometrioid ovarian tumor (or any other tissue that the endometrial tissue is attached to)
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What is the most common malignant and benign germ cell tumor?
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Malignant: dysgerminoma; benign: cystic teratoma
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What type of ovarian tumor is in Meig's syndrome? What two other symptoms are present?
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Fibroma (+ right sided pleural effusion, ascites)
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What is the time definition for sudden infant death syndrome?
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1 month to 1 year
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What type of choriocarcinoma does and does not respond well to chemotherapy?
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Germ cell choriocarcinoma does not respond well; complete hydatidiform mole choriocarcinoma does respond well
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What symptoms can elevated beta-HCG levels in choriocarcinoma cause? Why?***
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Hyperthyroidism, gynectomastia; because the alpha subunit is similar because it can activate the TSH, FSH, and LH receptors
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Most common cause of testicular tumor in a male age 3-15? 15-40? 60+?
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Yolk sac tumor, seminoma, lymphoma
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Does prostatic adenocarcinoma produce free or bound PSA?
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Bound PSA
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Is prostatic adenocarinoma based on architecture or nuclear atypia?
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Architecture (Gleason's grading scale)
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What type of bone lesions does metastatic prostatic adenocarcinoma cause? What lab values are associated with this metastasis?
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Osteoblastic lesions; elevated alkaline phosphatase, PAP, PSA
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What is the effect of hypo/hyper thyroidism on blood glucose and cholesterol levels?
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Hyperthyroid: hyperglycemia, hypocholesterolemia; hypothyroid: hypoglycemia, hypercholesterolemia
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Patient presents with arrhythmia, h yperthyermia, vomiting, and hypovolemic shock; dx?
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Thyroid storm (massive hormone excess)
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What are Hurthle cells?
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Eosinophilic cells in hashimoto's thyoriditis
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What thyroid cancer can cause dysphagia or respiratory compromise?
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Anaplastic carcinoma
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What is the effect of high levels of PTH on urinary cAMP levels? Why?
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High cAMP levels; PTH binds G(s) in kidney, activates adenylate cyclase, and increases cAMP!
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What tumor results in achlorhydria, cholelithiasis, and steatorrhea?
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Somatostatinoma (due to inhibition of CCK, gastrin)
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What ion distrubance occurs in VIPoma?
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Hypokalemia, achlorhydria
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What bacteria likes to cause chronic adrenal insufficiency?
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TB
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What metastatic cancer likes to cause chronic adrenal insufficiency?
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Lung cancer
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Where is the fasiculus gracilis and fasiculus cuneatus found?
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Gracilis central, cuneatus is lateral
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What enzyme is deficient in Krabbe disease? What compound builds up in the macrophages?
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Galactocerebroside beta-galactosidase; galactocerebroside
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What type of virus is HPV? (enveloped/non? ssDNA/dsDNA?)
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Non-enveloped dsDNA
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What is the effect of ApoE2 and ApoE4 on Alzheimer's progression?
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E2 is protective, E4 results in late onset
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What is pseudotumor cerebri?
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Also called idiopathic intracranial hypertension. Incresed ICP due to drugs => headache, nausea, vomiting, tinnitus, double vision.
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What protein makes up a Lewy body? Neurofibrillary tangle? Pick body?
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Lewy body = alpha synuclein; neurofib & pick = tau
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How does medulloblastoma metastasize?
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"Seeding"; drop metastases to the spinal cord and brain stem
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What brain tumor is characterized by perivascular pseudorosettes?
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Ependymoma
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What ion imbalance leads to acute pancreatitis?
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Hypercalcemia
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What is the MOA of ezemitibe?
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Inhibits cholesterol absortion in the gut
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What is the other name for eczema?
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Atopic dermatitis
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What is melasma? What causes it?
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Hyperpigmentation of cheeks associated with pregnancy ("mask of pregnancy") or oral contraceptive use.
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What's the difference between impetigo vs cellulitis?
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Cellulitis is a deeper infection of the dermis; has fever, soreness, erythema, etc.
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What is the most common cancer in immunosuppressed individuals?
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Squamous cell carcinoma (HPV, etc.)
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What are the three symptoms of Gardner's syndrome?
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Familial adenomatous polyposis, osteomas and soft tissue tumors, retinal hyperplasia, epidermal inclusion cysts, fibromatosis, and impacted/supernumerary teeth.
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What two factors cause immediate vasoconstriction of a damaged vessels?
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Endothelin, neural reflex
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What is the most common cause of secondary chronic ITP?
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SLE
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Boy presents with hemarthrosis with no family history of clotting disorders; DX? Why?
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Hemophilia A; commonly arises due to de novo mutations
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How do you distinguish between a factor 8 inhibitor and hemophilia A?
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Mixing study; add normal plasma to patient's plasma; hemophilia A PTT will be corrected (reduced) while factor 8 inhibitor PTT will not be corrected
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What two examples can cause an acquired disorder of fibrinolysis?
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Cirrhosis (decreased antiplasmin 2-alpha production), radical prostatectomy (release of tPA)
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What is the patient presentation of fibrinolysis defect?
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DIC WITHOUT any production of D-dimer
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What is the effect of a prothrombin 20210A mutation?
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Increases production of prothrombin, leads to hypercoagulable state
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Patient is given heparin but does not have an increase in PTT, what condition do they have?
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Antithrombin III deficiency
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If a drug has a high blood/gas solubility, what is its time of onset?
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Slow (insoluble gases have fast onset time; nitous oxide!)
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What is the presentation of M4 acute monocytic leukemia?
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Bloody / swollen gums
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What leukemia do Down's syndrome patient present with prior to age 5 and after age 5?
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M5: Acute megakaryoblastic leukemia (pre age 5); acute lymphoblastic leukemia (post age 5)
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What WBC neoplasia is caused by alkylating chemotherapuetic agents?
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AML
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Two CD markers for CLL
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CD5 and CD20
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What is the treatment for hairy cell leukemia?
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2-CDA (adenosine deaminase inhibitor)
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What leukemia presents with rash, lymphadenopathy, lytic bone lesions with hypercalcemia?
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HTLV-1
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What part of the lymph node is enlarged with carcinoma?
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Sinus histiocytes
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What does Cyclin D do?
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Promotes G1 to S phase
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What chormosome is Cyclin D found on?
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11
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What lymphoma is associated with chronic inflammatory states? (RA, Hashimoto's, Sjogren's)
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Marginal cell lymphoma
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Is hairy cell leukemia a B or T cell?
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B cell
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Besides phlebotomy, what drug can be used to tx polycythemia vera?
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Hydroxyurea
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What part of the lymph node is enlarged with early HIV and RA?
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Follicles
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What chormosome is IgH found on?
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14
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What chromosome is bcl2 found on ?
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18
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What is the normal kappa to lambda ratio? What does an abnormality suggest?
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3:1; monoclonality (lymphoma)
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Most common type of NHL is most common? Prognosis?
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Diffuse large B-cell lymphoma; poor, it is clinically aggressive
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What are classic CD markers for Hodgkin's lymphoma?
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CD15, CD30 and no CD20 despite being a B cell
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What causes masses in Hodgkins' lymphoma?
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Reed sternberg cells secrete cytokines, that attract NORMAL cells to make the mass (eosinophils, monocytes, lymphcytes, etc)
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What is the most common tumor of bone?
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Metastasis
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What is the most common primary tumor of bone?
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Multiple myleoma
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What is the most common cause of death in multiple myeloma?
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Infection! (monoclonal antibodies do not provide for a strong immune system…)
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What is Litterer-Siwe disease
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Malignant proliferation of Langerhans cells; skin rash and cystic skeletal defects in an infant <2 yrs, multiple organ failure
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What is eosinophilic granuloma?
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Benign proliferation of Langerhans cells; pathlogical fractures in an adolescent
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Hand-Schuller-Christian disease
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Malignant proliferation of Langerhans cells; diabetes insipidus, exopthalmos, skin rash and lytic skeletal defects >3 year olds
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What molecule prevents macrophages from utilizing iron in anemia of chronic disease?
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Hepcidin
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What happens to the TIBC in anemia of chronic disease?
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Decreases because transferrin decreases when ferritin is high
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What is HbH? What causes it?
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3 deletion alpha-thalassemia; tetramer of beta globulin (B4)
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What is hemeglobin barts? What causes it?
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4 deletion alpha-thalassemia; tetramer of gamma globulin
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What is a consequence of chronic beta thalassemia major treatment?
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Secondary hemochromatosis
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What is the most common cause of death in kids and adults with sickle cell anemia?
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Kids: encapsulated organism infections; adults: acute chest syndrome
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What is acute chest syndrome?
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Vaso-occulsion in pulmonary microcirculation; presents with chest pain, shortness of breath, lung infiltrates that is precipiated by penumonia
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What is the mutation in hemoglobin C?
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Glutamic acid is substituted with lysine
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What is the characteristic finding in hemoglobin C?
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Hemoglobin C crystals on peripheral smear
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What is the most common cause of death in paroxysmal noctural hemoglobinuria?
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Thrombosis of hepatic, portal, or cerebral veins
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What cancer is associated with proxysmal noctural hemoglobinuria? Why?
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AML; it's because the lack of CD55 is due to a mutation in stem cells, increases risk of other cancers
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What are intravascular hemolytic anemias?
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PNH, G6PD deficiency, cold agglutinin hemolytic anemia, babesia/malaria
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What type of hemolytic anemia is caused by warm agglutinin hemolytic anemia?
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Extravascular
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What are causes of warm agglutinin hemolytic anemia?
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SLE, CLL
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What are causes of cold agglutinin hemolytic anemia?
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Infectious mononucleosis, mycoplasma pneumonia
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What does a congenital parvovirus infection result in?
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Hydrops fetalis
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What is the function of CD14?
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Toll like receptor on macrophages, recognizes LPS
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What does toll-like receptor activation upregulate?
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NF-kB, which leads to the acute inflammatory response
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What are the three actions of LTC4,LTD4, LTE4?
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Vasoconstriction, bronchospasm, increased vascular permeability
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How and where does increased vascular permeability occur?
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Via contraciton of pericytes, that result in spaces between the endothelial cells; occur at post-capillary venule
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What activates the classical vs alternative complement pathway?
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Classical: C1 binds to IgM/IgM (GM makes classic cars); Alternative: microbial products direclty activate complement
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Is C4 seen in classic or alternative?
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Only classic
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What two inflammatory factors mediate pain?
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Bradykinin and PGE2
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At what point on the blood vessel does a neutrophil marginate and enter the tissue?
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Post capillary venule
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What is the result of the NTB test with MPO deficeincy?
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Normal (you can make superoxide, but not HOCl-
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What are the three IL's produced by TH2 cells?
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IL4,5,10
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What is the function of IL-10?
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Inhibits TH1 response
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What is the function of IL-5?
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IgA class switching, eosinophil chemotaxis
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What is the function of IL-4?
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IgE and IgG class switch
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Non-caseating stellate granuloma in the neck; dx?
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Bartonella henselae (cat scratch disease)
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What interleukin induces CD4 cells to switch to TH1 subtype?
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IL-12
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What three infections are characterized by Bruton's agammaglobulinemia?
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Bacterial, enteroviruses, Giardia
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What causes common variable immunodeficiency?
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Defect in plasma cell / B cell maturation
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Symptoms of common variable immunodeficiency? What are they at increased risk of?
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Acquired in the 20-30s; increased risk of auotimmune disease, lymphoma, sinopulmonary infections
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What type of immunodeficiency is present in Wiskott-Aldrich syndrome?
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Combined
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What is the function of PDGF?
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Endothelium, smooth muscle, and fibroblast growth factor
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What is the function of FGF?
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Angiogensis, skeletal development
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What is the difference between primary and secondary intention?
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Primary: edges approximated, minimal scar formaiton; secondary: edges not approximated, granulation tissue fills defect
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What ion is the cofactor of lysyl oxidase?
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Copper
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What type of hypersensitivity is Sjogren's?
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Type IV
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What serotonin drug is a 5-HT1a agonist, 5-HT1d agonist, 5-HT1a antagonist?
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Buspirone, sumatriptan, olanzapine
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What is the MOA and use of hydroxychloroquine?
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Stabilizes lysosomes and decreases chemotaxis; mild rheumatoid arthritis
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What is the side effect of hydroxychloroquine?
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Cinchonism, G6PD deficiency hemolytic anemia
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What NSAID can't be used with gout?
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Aspirin - it inhibits uric acid secretion
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What is the drug of choice for asthma if you are on beta blockers?
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Ipratroprium
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What is the effect of stimulating M3 receptors on blood vessels?
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Stimulates nitric oxide synthase => vasodilation
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Why don't indirect M3 agonists work on blood vessels?
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Because there is no innervation
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What is xerostomia?
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Dry mouth
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What drug should you use for an atropine overdose?
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Physostigmine because it cross the BBB
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What is the effect of low level chronic acetylchoinesterase toxicity?
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Peripheral neuropathy; demyelination
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What is the effect of atropine on an EKG?
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Widens QRS complex, QT prolongation
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What are the three C's of atropine overdose?
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Cardiotoxicity, coma (sedation), convulsions
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What is the effect of alpha 2 agonists on platelets?
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Aggregation
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What is the effect of alpha 2 and beta 2 agonists on insulin?
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Alpha 2 inhibits, beta 2 increases
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What is the effect of beta 2 receptors on the liver and skeletal muscle?
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Increase gluconeogenesis and glycogenolysis
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What is the MOA of methyldopa?
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Alpha 2 agonist used in hypertension for pregnancy
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What is the MOA of dobutamine?
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Beta 1 agonist
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What drug do you use to treat a depressed person with anorexia?
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Mirtazapine
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What two beta blockers have intrinsic sympathomimetic activity?
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Pindolol, acebutalol
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What is an ISA?
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Partial agonist
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What is the effect of beta blockers on lipids?
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Increase lipids b/c of inhibited lipolysis
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Which beta blocker has the most sedative effect? Which beta blocker can be used safely in patietns taking benzodiazepines?
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Propanolol; atenolol
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Are beta 1 or beta 2 receptors responsible for aqueous humor production?
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Beta 1
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What two diuretics do you use in glaucoma?
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Carbonic anhydrase inhibitors, mannitol
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How does hydrochlorothiazide and furosemide lower blood pressure?***
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HCTZ: opens K+ channels causing vasodilation, furosemide: increases prostaglandin synthesis, vasodilating kidneys
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What diuretics increase uric acid levels in the blood?
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HCTZ and furosemide
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What is the effect of quinidine on muscarinic and alpha receptors?
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Antagonist to both
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What antirrythmic is used o treat digoxin toxicity?
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Lidocaine
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What are some class Ic drugs?
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Flecinide, propafenone
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What are some class Ib drugs?
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Phenytoin, lidocaine, mexlitene, tocainamide
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What two drugs display digoxin from plasma binding proteins and increase its toxicity?
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Quinidine, verapamil
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What autonomic drug is used for opiate withdrawal? Why does it work?
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Clonidine; it decreases the sympathetic outflow so that the upregulated alpha/beta adrenergic receptors are not stimulated
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What is the method of guanethidine action?
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Inhibits norepinephrine vesicle fusion
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What drug could block the action of guanethidine?
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TCAs/cocaine
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What antihypertensive drug would you use for insulinomas?
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Diazoxide
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What two drugs can cause gingival hyperplasia
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Phenytoin, verapamil/diltiazem
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What antihypertensive drugs would not be used in someone with dyslipidemia?
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Beta blocker
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What ion does GABA(B) increase the permeability of?
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K+ efflux
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What muscarinic receptor is coupled to a potassium channel?
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M2 in heart
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What is the MOA of eszopiclone?
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BDZ1 agonists
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What is a non-sedating anti-anxiety drug? What is its MOA?
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Buspirone; partial HT-1A agonist
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What are all the drugs that have disulfiram like effects?
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Griseofulvin, cefotetan, cefoperazone, chlorpropamide, metronidazole
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What is the MOA of carbamazapine?
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Blocks fast sodium channels in their inactivated states
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What is an example of a zero order drug?
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Phenytoin, alcohol
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What anticonvulsant can interfere with folate and vitamin D absorption?
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Phenytoin, barbituates, carbamazapines
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What congenital defect is associated with phenytoin vs carbamazapine/valproic acid?
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Phen: cleft palate, carb/val: NTDs
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What anticonvulsant inhbiits GABA transaminase?
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Valproic caid
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What are all of the drugs that are associated with acute pancreatitis?
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Valproic acid, asparaginase, alcohol, didanosine, zalcitabine
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What anticonvuslant is assocaited with alopecia, hepatotoxicity, and thrombocytopenia?
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Valproic acid
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What anticonvuslant is associated with hirsutism?
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Phenytoin
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What anesthetic is great for an older patient with compromised cardiovascular function? Why?
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Ketamine, increases CV function
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What antiasthestic looks like milk and is used for its antiemetic effect?
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Propofol
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What is the MOA of fentanyl?
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Opiate
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What anesthetics increase intracranial pressure?
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Fentanyl, ketamine
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What pH is necessary to allow local anesthetic to enter neurons?
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High pH (local anesthetics are weak bases, need alkaline pH to be unioninzed)
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What form of a local anesthetic is active?
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Ionized
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What type of nerves are most affected by local anesthetics?
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Type B&C (non myelinated)
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What is a contraindication for ester anesthetics?
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Slow plasma and tissue esterase genotypes
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What is a contraindication for amide anesthetics?
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Poor liver function
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What type of anesthetic is more likely to have allergies via PABA formation?
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Esters
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Why is atracurium special? What is its major side effect?
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Safe in hepatic or renal imapirment; breaks down to laudanosine which causes seizures
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Why does mivacurium have such a short half life? What is the major contraindication?
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Esterase; if patient is a slow metabolizer you must contraindicate
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What is a contraindication for succinylcholine? Why does this occur? What conditions does this result in ?
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Slow metabolizer (atypical pseudocholinesterase); hyperkalemia and malignant hyperthermia
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How does morphine cause vomiting?
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Stimulates D2 receptors at the CTZ
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How does moprhine cause increasd IOP?
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Increased histamine release
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How does morphine metabolism make it more active? How is it cleared?
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Glucuronidation; normally by the kidneys; contraindicate with renal dysfunction or decrease dose
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What opioid has antimuscarinic effects? What does that mean?
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Meperidine; it doesn't cause pinpoint pupils and it can cause torsades du pointes
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Why would meperidine cause seizures?
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It is metabolized into normeperidine, a SSRI
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What is an example of a partial agonist opioid? What is a major concern with opioid partial agonists?
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Buprenoprhine; induces withdrawal
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What are two kappa agonists?
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Nalbuphine, pentazocine
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What is the method of signal transduction in opiates?
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G(i); lowers cAMP
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What is the method of tolerance in opiates?
|
Pharmacodynamics; increase cAMP levels to counteract the G(i)!
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Which MAO inhibitor will NOT cause a hypertensive crisis with tyramine? Why?
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Selegiline; it doesn't break down NE and 5-HT like MAO-A inhibitors
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What is the MOA of pramipexole?
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Dopamine agonists
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What is the only drug associated with livedo reticualris?
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Amantadine
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What is the effect of antipsychotics on weight and temperature?
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Hyperthermia and weight gain
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Which antipsychotic is most associated with retinal deposits?
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Thioridazine
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What is the MOA of aripiprazole?
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Parital D2 agonist; 5HT2 antagonist
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How does imipramine treat enuresis?
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Decreases phase 4 slow wave sleep
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What two side effects of trazodone are important? Why?
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Priapism, cardiac arrhythmia; alpha 1 blocker
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What is the MOA of mirtazapine?
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Alpha 2 antagonist
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What is the MOA of venlafaxine? What's its advantage?
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Nonselective NA/5-HT reuptake inhibitor; devoid of ANS side effects (like a TCA, but less side effects)!
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What is the MOA of buproprion?
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Dopamine reuptake inhibitor
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What is the MOA of lithium?
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Degrades PIP2, decreases cAMP
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What diuretics increase and decrease lithium toxicity?
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Furosemide/HCTZ increase toxicity, amiloride/triamterene decrease toxitiy
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How do you treat bipolar disease in a pregnant woman?
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Gabapentin, clonazepam
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What is used to treat trypanosoma cruzi?
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Nifurtimox
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Which NNRTI induces CYT P450?
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Nevirapine
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What bugs does aztreonam work on?
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ONLY gram negative rods
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What is the main antibiotic that increases QT interval?
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Fluoroquinolones
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What are the side effects of vancomycin?
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Red man syndrome, ototoxicity, nephrotoxicity
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What is the MOA of isoniazid?
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Mycolic acid synthesis
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What TB drug is contraindicated in G6PD deficiency?
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Isoniazid
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What ist he MOA of ethambutol?
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Arabinogalactan
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What are the three antibiotics that cause photosensitivity?
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Sulfonamides, tetracyclines, floroquinolones
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What drug is good to use osteomyelitis?
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Clindamycin, fluoroquinolones
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What two enzymes do fluoroquinolones inhibit?
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Topoisomerase II and IV
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What macrolide does NOT inhibit cytochrome P450?
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Azithromycin
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What macrolide should be used for macrolide resistant S. pneumoniae?
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Talithromycin
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What enzyme activates 6-MP?
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HGPRT
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What is the MOA of procarbazine? What is its unique side effect?
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Alkylating agent; causes AML
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What is the best treatment for lead toxicity in children?
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Succimer
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What is the major side effect of gingko baloba?
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Antiplatelet action; caution in patient who are taking anticoagulant
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What herbal supplement can cause serotonin syndrome? Why does it do it?
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St. John's wort; it is similar to 5-HT
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V(d) = ?
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Dose / [Concentration in plasma at time 0]
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Loading dose formula = ?
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V(d) * [concentration in plasma at time 0] / F
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What is a phase I reaction?
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Cyt P450 (oxidation, reduction, hydrolysis)
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What is a phase II reaction?
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Transferase reactions (glucoronidation, acetylation, glutathione)
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Why do you see gray baby syndrome with chloramphenicol?
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Because neonates have low levels of glucuronasyl transferase (phase II)
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How does a zero and first order graph look like in [units of drug vs time] and [log units of drug vs time]
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Zero order: linear, expontential decline; first order: exponential decline, linear
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Half life formula = ?
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0.7 * Vd/Clearance
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Maintenance dose formula = ?
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Cp x CL / F (Cp = target plsama conc, CL = clearance, F = bioavailability)
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Infusion rate equation (k0) = ?
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Clearance * C(ss)
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What are five common irreversible antagonists?
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Phenoxybenzamine, digoxin, allopurinol, PPIs, aspirin
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Do you prefer a high or low therapeutic index? What is the equation?
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Prefer a high; Toxic dose divided by effective dose
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What are four high yield drugs with low therapuetic index?
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Digoxin, warfarin, lithium, theophylline
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What type of singaling mechanism do cytokines like erythropotein, somatotropin, and interferons use?
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JAK/STAT
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What is the purpose of phase 1, phase 2, phase 3, phase 4 trials?
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1: safety and dosage in healthy pts; 2: effectiveness in disease patients; 3: effectivenessa nd common side efects in larger disease patient ; 4: post market surveillance, look for rare side effects
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What are CYP 450 inhibitors?
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Macrolides, amiodarone, grape fruit, isoniazid, cimetitidne, indiavior, ciprofloxacin, ketoconazoles
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Symptoms of theophylline toxicity?
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Abdominal pain, seizures, tachycardia/cardiotoxicity
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